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Home My WebLink About19802-z R FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAR'T`MENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20402 Date DECEMBER L0, 1991 THIS CERTIFIES that the building ADDITION & ALTERATIONS Location of Property 4875 NASSAU POINT ROAD CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. ].000 Section 111 Block 9 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 18, 1991 pursuant to which Building Permit No. 19802-Z dated APRIL 23 1991 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITIONS & ALTERATIONS TO EXISTING ONE FAMILY DWELLING _ AS APPLIED FOR. The certificate is issued to SELIM SAMAAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NfA UNDERWRITERS CERTIFICATE NO. N-205913 - SEPTEMBER 30 1991 PLUMBERS CERTIFICATION DATED DEC. 9 1991 - PECONIC PLUMBING & HEAT. Building Inspector Rev. 1/81 1'O7<l[ N0. f TOWN OF SOUTHOLD lUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. lUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- 19802 Z Date 19. A.1 Permission is hereby grant of promises/~ m .....~,r~..~.?.`~ ..r......~.1................................. .........Gr~~i..r........./1`.?:3f~..~.Q..4 ~.8~j~~.U ~.~1.... County Tox Mop No. 1000 Sect(on Block Lot No.........1~......... pursuant to application dated 19.~~ and approved by the Building Insp/ec/tar. Fee 5.....`~`~..7`~ Bui 1 1 r Rev. 6/30/80 ~~.5= Form No. 6 vw~, TOWN OF SOUT}fOLD ~ r~~ ~j r BUILDING DEPARTMBNT ~ ~'I ; TowN xALL T;;'~'~ ~~li'~0i991 . ~ 76s-lBOZ ~i 9, I,'. E.>f 1~s ~t»~.z..~,M,~ - , ~ S Gl.bS~. [3._~ t,, i ~l!`sfsd ti F' ~e Coi.! i 4°i ~i t~F: ~..,-.~,.x..,c~ APPLICATION FOR CGRTIPICATC OF OC'13""~'°`"`"`~"°""~~"`"~ This application must be filled in by typewriter OP, ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1~ lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. .S. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. r\ properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the ~ reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwellin g $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ~ 9 ~ . ':ew Construction........../. Old Or Pre-existing Building....~1 ' !.ocation of Property.... Zf~/~5 ..............N/4551?U~~{-/~'~.......Cv~C!'JC} (/e, _ House No. Street Hamlet „rawer or Owners of Property.:. ~ I M...S ~.rn 1gAn 11-(,vr ~Q ;:aunty Tax Map No 1000, Section....! //......Block...............Lot..,!.? .~ubdivisiun ..................FiC~led M;ip...~.....~J..Lot../.~................... i'crmlt ::o. ~.9~~Z;,,,,,,Date Of Permit.. ~/`~,'3~,/,~,,,,Applicant.0.:6~Yf"~-CJhr1 ~dnF~CiCF/(iG iicalth Dept. Approval ..........................Underwriters Approval.......................~. .'!.inning Board Approval .:e quest for: Temporary Certificate........... Final Certicate..~........ ~~cc Submitted: $ Q,ec.4 3 ov' CO ~~c`~ APP ANT ~ lfoiRtA M~ ~~t~ U~.e_„,,,x,~ PAGY # ~ - 1A401'dl ~ - .n- ~s r~+n arr. l~ew r+~iat. New res~rc soos~ SF.PYEMNEN 34,7991 7389249#J97 ri ?4591.3 C= qtr ./~7ic~tlon Ne. an JPlr wly tAe iM~1t1M~Mt r drertArd 6Aiw Alnd lnendred by the A~NOMt wwwtt~n tAR<.w6wr ~lfwt4w 1tYA1RtM~n flffll't+ntbp ~ ~ , $FL'J.N SAMI171~(, 4875 ~~''~~NgqASSAU POTN'C ttpkp, CI,JTCHO<,I1 bi, H.V. IntiwjMl~rvhyl t~ 1RA'F~'~~99iJ Me fl. ~ Tnd Fl. f+Ak/<)t)'t' Sr'tlw ~ - ~8>SPTR - ' NrAA eslnylRlyd Y11 and JoNnd to 6e in CYnY~ICAT'r rith the nrgr6r/nrr{r ~ thL 1wrJ. _ - lIIIICIIti orw11 AYT._ R. w. wAi. R. w.. AMT. tW. 'AMT.. w. n R_ _ _ 55 39 71 4.i 1 1.). 70 M' - ~ '1Mf11AN'~. ''...1MMlpM7~Mf - NLL AMT. R. W. ~ M.L M. 1. AMi. NO. A. W.O. AMT. AIM. AMT. AIAR. fRAMf. Nllt.~ N.?. AW. WATI6 m f t R Y 1 C t AM1. AID. MM 1 fW 1/i1A' 1/iN 1R tW .COND. 41D.q 1141!0 N0.aNMWi A'M' i*i 1~ p~ NOTOR3:1-4,75 H.P. PANFLBOARDS:J-4 CTN. #4fi ~ SMOKE DP;TF.CTOR : TRACK I17GN'fINC++:-8 . ~ di PAUL, k. NifRNS i~7C_}~?.M?.-E ?.75 TOMW HARBOR LAN}. SOOTROLn, t><v, 9.1.971, N~K V t . ~ 4': 3 - r ~ ~ T.. '..w - - _ Api c~~F F ~~,C TEL. 765-1802 TORN OF SO~JTF30d.D ~O ° ` OFFICE OF BUILDII~IG INSPECTOR o ,~4'`~ P.O. BOX 728 ~ ' TOWN HALL ~ ~ SOUTHOLD, N.Y. ] 1971 Cpl ~ ~b C E R T I F I CAT I O N , Date ~~~~/f Building Permit No. Owner (please print) / ~ ~ Plumber j'~,('„ /r /~~G/J~/J//L~ ~ /`YL~1~~/N~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. ( u er's signature) Sworn to before me this _~day of , c 19~. Notary Pu l'c notary Public, County e.ARea~asrePNOVVSUi Notaey Public, 5tata of New Xork No. 4844762 llualitiad in 5u9foik County Commission Expires 30,18 c7 INSPECTORS 7X~ Victor Lessard I~~'JfFt3(~- Principal Building Inspector ~yL® t'® Curtis Horton SCOTT L. HARRIS, Supervisor Senior Building Inspector °c~a d`; ~ Thomas Fisher f°' ~ ~ Southold Town Hall v" "r P.O. Box 1179, 53095 Main Road Building Inspector ~ ~y'~ Southold, New York 11971 Bu ldtang F pector Fax (516) 765-1823 Vincent R. Wieczorek ~ Telephone (516) 765-1800 Ordinance Inspector Robert Fisher Assistant Fire Inspectar OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD NOVEMBER 15,1991 ROBERT BOBN BO% 55 PECONIC, NY 11958 RE: Selim Samoan 6 Wife To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: ggg_ An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. ggg_ The check is (/not on file.}$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 19802-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. CC: SELIM SAMAAN 6 WIFE ~ ~ INSPECTORS ~u G~. , Victor Lessard ~9~~~~>bjs"rD(~ Principal Building Inspector Curtis Horton r.~" ti ~ SCOTT L. HARRIS, Supervisor Senior Building Inspector ~ ~ C"c,x. , ~ Southold Town Hall Thomas Fisher ! , ^lr P.O. Box 1179, 53095 Main Road Building Inspector ~'a Gary Fish .t Southold, New York 11971 ~ Fax (516) 765.1823 Building Inspector °i~rr~ Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD NOVEMBER 15,1991 ROBERT BORN BOR 55 PECONIC, NY 11958 RE: Selim Samaan fi Wife To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: ~ An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xgg_ The check is (/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 19802-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. CC: SELIM SAMAAN S WIFE c'1r:LD I;;SPcCTiU;7 ~IUAiF. ~ i;O.KMENT° ~ ` ~ ~ t . ~ O H _ _ - H FOUtJDATION (1st) ~ n/ FOUNDATIOtJ (2nd) p ~ rc OP~1. 2. ~ ~ z ROUGH FRAME & ~ w.oi.~c. 1~ ~ PLUMBING 3 . bDO ?LS 'T o AI~~-~' ~ ~ c~ "3 IIJSULATION PER N. Y. STATE ENERGY CODE 4. ~ f FI;JAL e ADDITIONAL COMMENTS: x~ x H ~ A ~ O Z 1 ~ h7 A ~H\\\ m ro H ~?rs-zsoz BUILDING DEPT. INSPECTi~~~ ( FOUNDATION 1ST [ ]ROUGH PLBG. (]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL RE ARKS: c~ DATE ~ O INSPECTOR , L ~ 765-1802 BUILDING DEPT. INSPECTION, [ ]FOUNDATION i5T [ j ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [~NAL - REMARKS: ~~r~ DATE / ~ / ~ INSPECTOR l 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ~ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ NSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ r r 4 I DATE ~ ` INSPECTOR l`~s~~z~ rss-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION i5T [vJ ROUGH PLB ~ C 6 ~ , (]FOUNDATION 2ND [ ] INSULATOON [FRAMING [ ]FINAL REMARKS: I~~-~,~.~-a , ~ L r _ ~-!-~:'r. DATE ~ 2 INSPECTOR New York State Department of Environmental Conservation Region 1 Headquarters V SONY, Building 40, Stony Brook, NY 11794 C, DATE: L~i~,~-~/~~/ /J_ Thomas C. Jorling y~5~( Re:~-'~73~ Commissioner x~ Dear ~~l ~ ~~i~n-Gtr-.c. ~ A review has been made of your proposal to: - ~°~s ~z.e;CJtin.~1. ~ C~ Sf~~~e_~ ~ i~e--a..e ~ss~¢.~.~ a~a--st. e~ Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that the parcel ~C~ project is: Greater than 300' from inventoried tidal wetlands. _ Landward of a substantial man-made structure greater than 100' in length which was constructed prior to 9/20 77. _ Landward of the 10' above mean sea level elevation contour on a gradual, natural slope. Landward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. Therefore, no permit-is required under the TidaluWetlands Act (Article 25 of the Environmental Conservation Law). Please be advised, however, that no construction, sedimentation or disturbance of any kind may take place seaward of the 10' contour or topographic crest without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation in this area as a result of your project. Such precautions may include providing adequate work area between the 10' contour or topographic crest and the project (i.e. a 15' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. Please note that any additional work, or modification to the project as described, may require authorization by this Department. Please contact this office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. " Very truly yours, h Deputy Regional Permit Administrator t _ a Y ~ ~(~-~5~-~ P®C i C~ u ~ ~s.~ Cu l c. X10 G ~ su1~Di ~Z `Qr ~o t~ tad ~C L~ S `r o ~ t~T I~~G [ ] OUN ATION 1ST [ ] F DATION 2NC [ 7 RAMI ~ o` REMARKS: t >~l'~ l tsar (1 'j I \ DATE ~ Z INSPECTOR TOWN OF SOUTI [OLD _ BUILDING DEPART~~tENT SOUTFIOLD, NE1V YORK STOP WORK O R D C R Tp: ROBERT BOHN CONTRACTING Owner, Uwner's Agent or Person Perrormmg 1Vortc) ' P.O. Box 55 - Peconic, N.Y. Aaaress of aoove-namea person/ YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: 4875 NASSAU POINT~ROAD, CUTCHOGUE, NEW YORK (Aaaress wnere work is to be stoppea) , TAX biAP NUPABER 1000-111-09-10 Pursuant to section 100-281 of the Cade of the Town of Southold, New York you ate notified to immediately suspend all work and bui]ding activities uncil this order has been rescinded. BASlS OF STOP WORK ORDER: ALTERATIONS AND ADDITIONS REQUIRE A BUILDING PERMIT BEFORE WORK CAN BEGIN. • CONDITIONS UNDER WHICH WORK MAY BE RESU~b1ED: WHEN A BUILDING PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. Failure to remedy the cdnditions aforesaid and to comply with the applicable provisions of ' law may consrirucc an offcruc punishable by fine or imprisonment or both. DATED: MARCH 22, 1991 ~J / CODE ENFORCBIIENT OFFICER VINCENT R. WiECZOBEK cc to: SELIMA SAMAAN, 80 ETON ROAD, GARDEN CITY, N.Y. 11530 • ' . ~ x ~ ~.ra.~. .3..._. .r,....._. ex~rrr ~.,„...:'~.zv~..u ns'AUaa-w~'-.~ekta...~€~+,'. TOWN OF SOUTIfOLD _ BUILDING DEPARTMENT SOUTIIOLD, N6~V YORK STOP WORK ORDER ~ TO: 120 ~ F ?2_ {~C8 d~ 3-E Cp ~C. 112..'4 t ~ C-z (Owner, Uwner's Agent or Person Pertorming Work) ~,0. 130X. SS" ' 'P~~,~.o~tc. u.Y Aaazess of above-named personl YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: Y$Z~° u~4SSA~ ~41?c ~ 2o~h, Cu~c.c?~~v~ I,.1,Y, (Aadress where work is to be stopped) ' TAX MAP NUMBER /Od t? - ° Q ~ ~ / ~ Pursuant to section __~Q - ~ of the Code of the Town of Southold, New Yozk you are notified to immediately suspend all work and building activi[ies until this order has been rescinded_ BASIS OF STOP WORK ORDER: ~ (p ~ r~.~.Iq "1""'"t o ~ ~Q- ~ } j~~ ~ 1 `p-I p t„{ ~ ~~glq R ~ E 1< ~ t ~ G-, Q N.t e i " E~, J~„ tw;~. c.v o 121- G ~4 t~f ~ t , . CONDITIONS UNDER WHICH WORK MAY BE RESUMED: U.J p.¢ y~ ;~U ~ F ~ ~ 121M t i I~f ~ 5 ?3 ~~~~t 1 S ~ ~ E~;~ i3 y 7-~f r~ ~ u s ~ t Failure to remedy the ctinditions aforesaid and to comply with the applicable provisions of law may cortsticu[e an offense punishable by Einc or imprisonment or both. DATED: ~~`l ~f - BUILDING INSPECTOR /CODE ENFORCE1fENT OFFICER i _i, c., it,~ n I b ~ ~ _ I _ '.I rq r~ c d x x ec x 'tti R'1 i I w. n ~ ~ ~ c~riyy ~ 1 4 h' C N N n i Y P .dr ~ C 4- b! ~ F. O i ~ i h~ Nrfiona ~ > G a ~ J,.' M T I'~ ~ I~..,n~, b s i it I ~ H ' °''s C., ~i lip".} ~ ~ H M Vf ~ N ~ N i (A G I ~ iI ! ~i N w ~d m p p o m ~ q n I i n ti.t r~ N m m p to T T' fT1 ~ ~ ~CVJ: VA O ~Hp ~ A ~ Ipj In ~ lr i II ~ J' NJ N ~ ~o ~C C H :pn L.. M ~ ~L ~pw~m m~o , ~ ~ of°!r` ~ of i, ' upi o o ,n p m i it o Ir, j~ i T I n< y~mHNm~.+ I ie ~ nl .,0 I'ti~ ~~~p MM~~ ~ M P't ~ ~ ~ ~ y O ~NH p:vroMC i IVY M ~ ~p ' r m d H ~MF+~~ II I ; C m m~ M ~ 1 V ~ ~ , m .or o ~ ~ ~ ~ ' ~ ~ ~ ~ ~ ~ ~ ~ ~`I ""'fJ 00 ~ I' ~ IN i I ^'1w, H H v U ~ ' i I~ T; m' 0p ~H`" I ~ ~ I ~ ~ I Sri m ty ~ ~ ~ ~ E a ~ . ~ . ~ vin ~ 1 ~ ~ .,L..~_ ~ ~ 1 4.n U r ~ ~ ~ I ! 'T'' i ~ I~ ~ ~ , o ~ I I ,o ,y ~ ~ I <V ~ r I ~ I a l,l i ~ I - _ E - I --f- _ ~_~.._-~I_ - - ~ ,i ~ I I J t d o a o ~ ' N N N~ ~ I ~ I I~ ~9 ~JJ G ~ 41 1 1 S~~ ' _..I_..__, I I x ~P'h ~ 5 ' ~ ~I ' x b o V ! ~ I m r m yr I i i n ~ o % b I ~ M"n l~ h • + I } ~ i tin,. { ~ ~ m I ~ ~ I ~ ~ ~ ~ ~ Nff j i i~ y ~ ~ i rzJ~~~:.. 1 ~ I ~ ~ i ~ o b~ ~ I ~ II ~ tee' j I I I t ~ I ` ~ { I r_ M BOARD OF HEALTH ~9~',`}4 3 SETS OF PLANS } ~ , _ FORM NO. 1 SURVEY , ~d" TOWN OF SOUTHOLD CHECK MAR2QI991 i'' BUILDING DEPARTMENT SEPTIC-FORM-•,,,,,,,,,,,,,, jl ~ ~ TOWN HALL r~hl-.°"''~~ SOUTHOLD, N.Y. 11971 NOTIFY . ~6`~ /l/•~• ®LD!l. Cs?::,-r. CALL TOVJ(N c)F F~~lu-iNtltf; ~ TEL.: 765.1802 ' ,....M.... MAIL T0: Examined , , , , , . 19'x1. Approved ..Jf./,.~........, 19~,~Permit No..1.~~0 Disapproved a/c 1P~„ . . (Bull ing In ector) APPLICATION FOR BUILDING PERMIT - Date .rlars=h..18........, 1992. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 cats of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- bation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinan uilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for nee sary i ections. (Sj~a~u~of ~pllli~an r n me 'f a` corpor~n~~~9' (k~~ J ~ J~ 80„>ltop„l3gad,,,,G~r, en-City,-N; Y.,,, 11530, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...........OydNER Name of owner of premises Selima.8alnaan (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. .75111..H1 . Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done. NaSS.aU. pt,., ,ggad,,,Nassau , pt,.- ,Cutchogue, , .11935 .4$75 1`Ias,~au„Pt; ,Road.............Cutchogue.......: House Number Street Hamlet County Tax Map No. 1000 Section ..111 Block Q.... - . Lot ..~-:..~Q. , , , , ; , , , Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy flN.>i .k'AM~.>iX. AW.ELLI.NG , , , , , , , , b. Intended use and occupancy , ,ONE FAMILY DWELLING . s ~ I 3. Natur~of work (check which a{Splicable): New Building , , , , , , , , Addition ..X....... Alteration X, , Repair Removal Demolition Other 1Vork • ~ ~ ~ • ~ • ~ pS~ripSion) 4. E$~imated Cost .13A.~.449..•.44 , , ~/9~~ ~ ` Fee...Y. ,T.~~ ` ito be paid on filing this application) 5 If garagennumber of ~s ~Woglunits one • • • • • , • , , Number of dwel]ing units on each floor . . ~Ca>'..garage,..... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use , . 7. Dimensions of existin structur g es, if any: Front Rear . , Depth . Height ...............Nunl6erofStories....,......................... Dimensions of same structure with alterations or additions: Front Rear . Depth ...................:..Height , . Number of Stories . • , . 8. Dimensions of entire new construction: Front , , , , , , , , , , , , , Rear ,Depth Haight Nw~~ber of Stories . 9. Size of lot: Front_ , , , Rear ...Depth . . 10, Date of Purchase . .............................Name of Former Owner . 11. Zone or use district in which re P P p misesaresituated,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,•• 12. Does ro osed construction violate any zoning law, ordinance or regulation: . 3. Will lot be regraded 14. Name of Owner of,premis~es ' ' ' • • ' ' ' ' • • Will excess fill be removed from premises: Yes No • • • • • • • • • • .......Address ...................Phone No, . Name of Architect ..........;L , , , , , , , , , , , , ,Address ...................Phone No..:............ . ame o ontrac or . Y , .................Address )'hone No................ P P Y 15. Is this ro ert located within 300 feet of a tidal wetland? *Yes , No *If es Southold Town Truntees Permit may be required. 1 PLOT DIAGRAM Locate cleazly and distinctly all (buildings, whether existing or proposed, and indicate all set-back dimensions from" property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. I i III i STATE OF 1\E1V YORIC, COC~NTY OF . Si,S "'••'•••••••••••••••••••••e••',••••••.~•••••...•.. being duly sworn, deposes and says that he is the applicant (Name of individual si^nirtig contract) above named. 'le is the .......................I~..... (Contractor, agent, corporate officer, etcJ if said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in t}tis application are true to the best of his knowledge and belief; and that the vork will be performed in the manner set forth in the application filed therewith. 1 7worn to before me this rotary Public, ~:'.`:5-? Yf', :..~C!c ; County NELEN K DE VOE ~ .V~ , - . • , • . . NO711ftY PUBLIC, State of New York . lfo.4707878,5u9tMkCau~-, (Signature of applicant) Term Expires March 30,1 •